Chipping Away at Conventional Wisdom

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News broke this week that Safe Streets, a Washington, D.C.-based anti-crime group, has filed two lawsuits in federal court regarding marijuana law. In one suit, the group plans to target government officials in the state of Colorado over their alleged violation of the Supremacy Clause of the U.S Constitution. The group contends that by “promoting the commercialization of marijuana,” Colorado has acted in direct violation of federal narcotic laws. The other suit names several prominent Colorado-based business owners who work in the cannabis industry.

Regardless of the group’s knowledge of how to spell marijuana, this incident is another in a long line of attempts by politicians, government officials, law enforcement, special interest groups, religious leaders, and newspaper columnists to halt the decriminalization of marijuana possession and dissuade the public from voting to legalize marijuana for medicinal and recreational use.

Arguments and rebuttals against this diverse onslaught of pundits have originated from a variety of mediums. From rallies and demonstrations on Capitol Hill to Congressional lobbying to lengthy op-eds and dedicated blogs, the fervor for legalized marijuana is as strong as ever. One of the most popular strategies employed in this battle has been to evoke the supposed health benefits of marijuana use.

While the science is burgeoning, it is also deeply flawed, filled with holes and questions, and is too poor to extract any conclusions from one way or another. Relying on this research to frame and support an argument favoring marijuana legalization is dicey at best; one can’t get far with shoddy incomplete data and assumptions. Regardless of this reality, the pro-marijuana crowd has soldiered on undeterred, boasting study after study purporting to demonstrate the efficacy of cannabis and it’s ingredients in treating any number of health conditions.

This appears to be the best method for bringing about legislative change to decriminalize marijuana. But, in addition to the uncertainty surrounding the whole of the marijuana scientific literature, there are other untoward possibilities that could result from this tactic.

To the fearless recreational users crying for reform, the ambitious grassroots organizations lobbying their representatives, the bloggers unearthing obscure studies, and the cancer patients asserting it’s palliative effects, I have one word for you:

Stop.

Stop trying to educate the public about the potentially health-promoting effects of marijuana. Stop trying to convince our policy makers that cannabis is not a danger. Stop invoking tales of chronic pain alleviated, of headaches relieved, of vision loss arrested, of anxiety calmed. Stop playing this game.

This situation is reminiscent of a child begging her mother to buy a particular snack food at the grocery store. “But mom,” she whines, “it’s healthy!”

Its the mother’s choice as to whether or not she’ll buy the junk food. The little girl believes that her pleading and bargaining is helping her cause, giving her some influence over the decision. But ultimately it may be for naught. It may just be serving to further define their two roles. Mom is in charge and she knows best. The little girl is at the whim of the mother’s judgement and there’s realistically not much she can do about it.

Now replace the mother in this situation with the federal government. The fussing child is the public, the tax-paying citizenry, clamoring for cannabis to made lawfully available to them.

Is this the precedent we want to set? Is this how we want our government to treat us going forward? Do we want to succumb to the nanny state by acting like little children who do indeed need a nanny?

We as citizens should not bear the burden of demonstrating the safety of everything we want to consume. We aren’t particularly adept at it, especially considering the questionable quality of data and flimsy biology with which we’re equipping ourselves in this battle. The results of a few studies and copious anecdotal evidence might have aided in getting the ball rolling in Colorado and Washington State, among other states, but in order to finish this fight against an overbearing, overreaching mommy-knows-best government and thus be free to smoke marijuana in the comfort of our homes, we don’t need to assume the position of a submissive, compromising, and desperate populace.

We shouldn’t be throwing statistics and purported benefits at the wall in the hope that something sticks. Hold strong to your convictions and forget the burden of proof; it shouldn’t be on us. And if it is, no data, no matter how compelling and noteworthy, is going to reverse our role as the angry child in the grocery store begging for cookies from an overprotective mother.

The nanny state won’t be swayed by numbers. Unless, of course, those numbers are dollar figures.

Let’s say the time has come for you to improve your health. You’ve noticed that your clothes are getting tighter and that your annual winter cold has lingered longer than usual. It seems more difficult to do yard work without feeling short of breath. You lack energy and your back always hurts. Say that you want to stop smoking, too.

How do you fix these problems? What’s the best way to get in shape? To lose weight? To lower your risk of disease? How can you reduce joint pain? An Amazon.com search of key phrases like “weight loss” or “diet” leads to an overwhelmingly dense and diverse selection of books. How do you know which has the right information, the advice you need to begin following a healthier lifestyle?

You could turn to a lot of resources for answers. The Cochrane Collaboration is a not-for-profit organization of volunteer researchers who provide thorough analyses of data comprised from the results of dozens of randomized controlled trials, the gold standard of research design, in order to determine the most effective treatments for a host of medical conditions. Using a discerning and highly-selective standardized methodology and unadulterated by the financial influence of outside sources, the group provides physicians and healthcare practitioners with “best practices” backed by data that can be trusted to be accurate. See the Cochrane Library for the results of these meta-analyses concerning a number of health conditions.

But medical literature can be intimidating to and difficult to understand for a layman. You risk encountering any and all degrees of quackery sifting through blogs, social media, TV shows, magazine articles, news columns, and internet videos for health advice. Family members and coworkers might not be of much help. Personal trainers, supplement store employees, and nutritionists can provide conflicting and incorrect information. Your doctor may just pull out the prescription pad and hurry you out the door when all you wanted was some guidance. It’s easy to feel misled and overwhelmed.

So let’s turn to our government health agencies for help.

And since we want to improve our overall health, let’s try to follow all of the health recommendations made by these federal agencies.

Is it even possible to live the nanny state lifestyle? How useful is the information that these agencies provide the public?

The U.S. Department of Health and Human Services (HHS) is one of fifteen executive departments of the federal government and an umbrella agency for a number of federal agencies and centers aimed at “protecting” the well-being of all Americans. Below is a partial list of the divisions that operate under the administration of HHS and that provide health recommendations and/or guidelines for the general public:

In addition to these agencies and their own multitude of offices, there are other executive departments which publish health recommendations. The Department of Agriculture (USDA) and Department of Labor (DOL) both offer detailed directives against developing chronic disease and sustaining injury, respectively.

For the purposes of our discussion, we will analyze the main public health recommendations proffered by the aforementioned agencies. Certainly with some more research of the other federal departments we could uncover additional suggestions for maintaining or improving our health. This post is not meant to be an exhaustive review of every piece of health information dispensed by our government’s myriad voices of authority.

What we’ll instead attempt to do is answer these questions: Can an Average Joe expect any benefit by following these guidelines? Can he do so without having to do time-consuming research? Can we the public, a nation of Average Joes, follow government advice without doing a disservice to our health, our sense of well-being, our family, our free time, our privacy, and our liberty?

The Average Joe might indeed have a bad back, a smoking habit, some extra weight, and maybe even a little depression. Let’s say Joe can use an internet search engine to find popular medical websites that espouse basic health information. Joe cannot, however, interpret papers from medical journals. Distilling scientific research into usable information is just not in Average Joe’s wheelhouse.

So Joe will turn to government health agency websites for help.

Let’s start with those extra lbs. What’s Joe supposed to eat if he wants to maintain a healthy weight and minimize his risk of disease? The USDA’s Dietary Guidelines Advisory Committee, who work in the Center for Nutrition Policy and Promotion (CNPP), an agency of the USDA’s Food, Nutrition, and Consumer Services mission area, release every five years the Dietary Guidelines for Americans in collaboration with HHS. This hundred-plus page document is meant to summarize the best available scientific literature concerning nutrition, overweight and obesity, and chronic disease and provide to all Americans over age two sound research-based guidelines for making healthy food choices. The next version of this document is expected to be released in Fall 2015.

For our purposes of deciding what to eat to facilitate weight loss, we’ll first use the four-page executive summary, as no busy American can be expected to read the entire voluminous Dietary Guidelines report.

If Joe wants to lose weight, he’s going to have practice “calorie balance” according to this report. Also known as energy balance, this entails counting the calories in everything you ingest and also estimating how many calories you burn through resting metabolism and physical activity. Although poorly understand and nearly impossible to do accurately long-term, practicing energy balance is the go-to method for losing weight as prescribed by the U.S government. This is in spite of a growing body of evidence from research that seems to demonstrate that it is, at best, a theory in need of further study.

So Joe is going to have to calculate the calories of everything he eats and the energy requirements of everything he does. Is that any way to live? Can Joe enjoy food and enjoy life constantly worried about portion sizes and calorie expenditure? Luckily for Joe and the rest of us, the CNPP has an online tool for tabulating this data, the SuperTracker, which provides calculators for physical activity, food choices, and a personalized weight management system.

For practicing energy balance to be efficacious, Joe will (theoretically) have to count calories all day, everyday, presumably lifelong. It wouldn’t be too far fetched to assume that this process could lead to one of two outcomes: Joe gives up on the whole idea, or he becomes obsessively focused on it at the detriment of a healthy relationship with food and his own self-image.

What foods should comprise Joe’s new healthy diet? The 2010 Dietary Guidelines executive summary counsels all Americans to choose low-fat protein sources, get plenty of fruits and vegetables, emphasize whole grains, and avoid sodium and dietary cholesterol (they’ve changed their tune on this one, however). The full document is worth a cursory glance but perhaps other government resources could be more illuminating. For example, the Dietary Guidelines Advisory Committee releases to the public “Nutrition Insights” which are brief literature reviews aimed at providing Americans with tangible research-backed dietary information.

If Joe wants to know what to eat for breakfast to help him lose weight, he’s in luck: this very topic was covered by the Committee in 2011. For reasons unspecified, however, they failed to “review the literature on the use of breakfast consumption as a tool for adults actively losing weight.” Curious decision seeing as how adults, not children, seek the help of these guidelines as they try to lose weight. Previous incarnations of the Guidelines have netted similar complaints. Good thing the USDA has instead focused their research efforts (and funding) on more pertinent topics such as whether Americans like to eat sandwiches and how to measure a piece of cake. Or maybe they’re too busy playing with their food.

Looks like Joe has exhausted the help of the USDA. Sure, they have issued other recommendations for healthy eating, but Joe is a little confused by the ambiguity of the Dietary Guidelines. He’s certainly not the only one.

But the USDA does have the Nutrition Evidence Library (NEL), a sort-of government-sponsored version of the Cochrane Collaboration, except dealing in only dietary matters. With eight topics ranging from energy balance to food safety, the NEL’s reviews cover plenty of issues applicative to Joe’s quest for health. There’s only one problem: the NEL, despite its collaboration with “leading scientists” to create “systematic reviews,” makes a blunder most high school statistics students wouldn’t make. They confuse correlation with causation. In matters of public health, a slip-up of this magnitude, apparent throughout the NEL’s reviews, could have disastrous consequences.

Vague advice is one thing but recommendations riddled with potential mistakes are another. This is Joe’s health we’re talking about. We have to get this right.

After perusing the content of the MyPlate website, several things become apparent to Joe. The most perplexing is the concept of tricking yourself into eating less. Take a look at this guide on portion control. The USDA is assuming that smaller plates are a key strategy in conquering the obesity epidemic. The problem with this logic is that it just might not work.

Can we fault the USDA for being a little behind the research? We could especially considering how busy they are saving us from bad shrimp and imported pork rinds and crafting over a hundred documents on nectarines and peaches grown in California. At least they can define for the discerning public what a catfish is.

But it looks they can’t help Average Joe lose weight.

Research is surprisingly inconclusive on what exactly constitutes a healthy diet. Although they attempt to designate which foods can and cannot be labeled as healthy, the reality is that the literature is ambiguous. The USDA’s nutrition recommendations are at best an educated guess and might very well be a good starting point for Average Joe looking to drop some weight and improve eating habits. But doubts over their accuracy and usefulness have persisted throughout the federal government’s tenure as health educators. An internet search of critiques of the USDA’s Food Pyramid is illuminating.

Would it hurt Average Joe to just eat more fruit, pass on the salt, and maybe cut down on the red meat? Probably not. (The salt thing is debatable; actually, it’s all debatable, but we’re running out of room). These guidelines can give us some semblance of informed counsel on dietary matters but their research certainly is not airtight. To us as citizens, as naive consumers, as a people rapidly getting sicker, the USDA, despite their best efforts, are lacking as a resource.

Other federal agencies which cover nutrition, such as the FDA, might be better in this regard. But they’re more caught up in food labeling which does have undeniable value. One could make the case, however, that they get a little carried away with this responsibility. Consider this forty-four thousand word document on how to quantify the serving size of fruit cake and breath mints.

Could the CDC be our source of usable, accurate, and detailed information? Their Division of Nutrition, Physical Activity, and Obesity offers some guidelines on healthy foods, and although these are aimed at food service, we can still potentially glean some individual advice. But something strange appears on their page detailing “healthier choices:” 100% fruit juice. With the help of the FDA, we as consumers can read the labels on many fruit juices and find alarming amounts of sugar and high fructose corn syrup. See this video for an initiation into the research of these substances on human health. The literature on this deleterious effects of sugar is growing exponentially. To pick a couple papers would do a disservice to the research as a whole. This considered, it’s certainly odd that the CDC, in its quest to prevent disease, is hocking a nutritionally-worthless and insidiously disease-causing food.

Average Joe still has a gut, however, and would like to lose it. It’s no surprising that upping consumption of fruits and vegetables is a tenet of the CDC’s weight loss dogma. Consider their Weight Management Research to Practice series which discusses for health professionals, in the hopes they will provide clients and patients with this information, the “science on… weight management.”

One look at the recommendations for fruit and vegetable consumption, housed in a “research review” for practitioners, reveals an almost laughable admission: “no studies have directly linked consumption of fruits and vegetables to weight loss.” That doesn’t mean they don’t know that eating these foods causes weight loss. They don’t even know whether or not there is a relationship between eating these foods and body weight. How can they have built an empire of recommendations on healthy eating when one of their key pillars is not supported in any way by any research? And how can you review the literature when you admit that no literature exists for your particular topic?

The average person simply doesn’t have the time or the education required to peruse medical journals and read human physiology textbooks and glean from them practical information on how to live healthily. It could be argued that the federal government’s public health agencies are doing us a favor by condensing down this huge morass of data and complicated biology and extrapolating from it simplified guidelines on what to buy at the grocery store and how to prepare it at home. The sheer amount of funding required for this undertaking, provided by our tax dollars, suggests this argument is invalid. A more productive argument would be whether or not our government should be spending our money to provide nutrition guidelines in the first place.

In Part Two, we will examine the government health agencies’ advice on physical activity, smoking cessation, and mental health.